Progression towards microelimination of hepatitis B virus infection among people living with HIV in Spain.

Introduction: The WHO proposed to achieve hepatitis B virus (HBV) elimination by 2030, but this goal is very difficult to attain. People living with HIV (PLWH) may represent a subset where microelimination can be reached sooner. This study aimed to assess the incidence of HBV infections and changes in the prevalence of active HBV infection among PLWH in Spain.

Methods: A prospective cohort study, including all PLWH attending a university hospital in Southern Spain from January 2011 to December 2022, was conducted. Serum HBV markers (HBsAg, anti-HBs, anti-HBc) were tested at baseline and at least yearly afterwards. Incident cases were identified by anti-HBc seroconversion.

Results: Nine hundred and eighty PLWH were included. At the beginning of the study, 26 (2.7% [95% CI: 1.7-3.8%]) tested positive for HBsAg, 428 (43.7% [95% CI: 42.8-49.4%]) for anti-HBc and 386 (39.4% [95% CI: 39.8-46.3%]) for anti-HBs. After a median (Q1-Q3) follow-up of 115 (35-143) months, two new infections were documented, yielding an incidence rate of 2.24 (95% CI: 0.27-8.1)/100,000 person-years. The prevalence of active HBV infection declined from 3.4% [95% CI: 2.0-5.0%] in 2011 to 2% [95% CI: 1.0-3.0%] in 2022 (p for linear trend=0.027). At the end of the study, 167 (24%) PLWH still were susceptible to HBV.

Conclusions: The incidence of HBV infection among PLWH in Spain is close to the WHO target. The prevalence of active HBV infection has decreased substantially during the last 12 years. These data suggest that micro-elimination of HBV/HIV infection is on the track in Spain.